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When comparing primary outcomes between African-Americans to non-African-Americans, there was no statistical significant difference in mortality rate and recurrent stroke rate between the two groups. CONCLUSION This study found no statistical significant difference in the incidence of recurrent stroke and mortality between mono antiplatelet therapy and dual antiplatelet therapy among patients who had ischemic stroke or TIA; with similar findings in a subgroup analysis comparing outcomes in African-American patients compared to non-African-American patients. This article is protected by copyright. All rights reserved.Elevated levels of cardiovascular disease (CVD) risk markers are highly prevalent in people with a spinal cord injury (SCI). Breaking up prolonged sedentary time with short, regular bouts of physical activity can reduce postprandial glucose and lipid levels in able-bodied individuals. The effects in people with paraplegia are unknown. The study aims were to examine the acute postprandial glucose (primary aim), lipid, blood pressure and psychological responses (secondary aims) to breaking up prolonged sedentary time in individuals with paraplegia. 4HNE This was a randomised crossover design trial. Fourteen participants with paraplegia (age 51±9 years, trunk fat mass 44.3±7.7%) took part in the following two, 5.5 h conditions (1) uninterrupted sedentary time (SED), and (2) sedentary time interrupted with 2 min of moderate-intensity arm crank ergometer physical activity every 20 min (SED-ACT). Standardised breakfast and lunch test meals were consumed during each condition. The outcomes were compared between conditions using linear mixed models. Glucose area under the curve (AUC) was significantly lower during the lunch postprandial period in SED-ACT versus SED (incremental AUC 1.9 [95% CI 1.0, 2.7) and 3.0 [2.1, 3.9] mmol/L∙2.5 h, respectively, p=0.015, f=0.34). There were no differences between conditions for the breakfast or total 5.5 h postprandial periods (p>0.05). Positive affect was higher in SED-ACT than SED (p=0.001). Breaking up prolonged sedentary time acutely attenuates lunch postprandial glucose and improves positive affect in people with paraplegia. This may have clinical relevance for reducing CVD risk and improving psychological wellbeing in this population. This article is protected by copyright. All rights reserved.BACKGROUND The Weberian apparatus enhances hearing in otophysan fishes, including Zebrafish (Danio rerio). Several studies have examined aspects of morphological development of the Weberian apparatus and hearing ability in Zebrafish. A comprehensive developmental description including both hard and soft tissues is lacking. This information is critical for both interpretation of genetic developmental analyses and to better understand the role of morphogenesis and integration on changes in hearing ability. RESULTS Histological development of hard and soft tissues of the Weberian apparatus, including ossicles, ear, swim bladder, and ligaments are described from early larval stages (3.8 mm notochord length) through adult. Results show a strong relationship in developmental timing and maturation across all regions. All required auditory elements are present and morphologically integrated early, by 6.5 mm SL. Dynamic ossification patterns and changes in shape continue throughout the examined developmental period. CONCLUSIONS This study provides the first comprehensive histological description of Weberian apparatus development in Zebrafish. Morphological integration was found early, before increases in hearing ability were detected in functional studies (>10 mm total length), suggesting morphological integration precedes functional integration. Further research is needed to examine the nature of the functional delay, and how maturation of the Weberian apparatus influences functionality. © 2020 Wiley Periodicals, Inc.Disturbing the circadian regulation of physiology by disruption of the rhythmic environment is associated with adverse health outcomes but the underlying mechanisms are unknown. Here, the response of central and peripheral circadian clocks to an advance or delay of the light-dark cycle was determined in mice. This identified transient damping of peripheral clocks as a consequence of an advanced light-dark cycle. Similar depression of peripheral rhythm amplitude was observed in mice exposed to repeated phase shifts. To assess the metabolic consequences of such peripheral amplitude depression in isolation, temporally chimeric mice lacking a functional central clock (Vgat-Cre+ Bmal1fl/fl ) were housed in the absence of environmental rhythmicity. In vivo PER2LUC bioluminescence imaging of anesthetized and freely moving mice revealed that this resulted in a state of peripheral amplitude depression, similar in severity to that observed transiently following an advance of the light-dark cycle. Surprisingly, our mice did not show alterations in body mass or glucose tolerance in males or females on regular or high-fat diets. Overall, our results identify transient damping of peripheral rhythm amplitude as a consequence of exposure to an advanced light-dark cycle but chronic damping of peripheral clocks in isolation is insufficient to induce adverse metabolic outcomes in mice. link2 © 2020 The Authors. Journal of Pineal Research published by John Wiley & Sons Ltd.INTRODUCTION Acute hemopericardium during cardiac electrophysiology (EP) procedures may result in significant blood loss and is the most common cause of procedure related death. Matched allogeneic blood is often not immediately available. The feasibility and safety of direct autotransfusion in cardiac electrophysiology patients requiring emergency pericardiocentesis is unknown. METHODS We retrospectively analyzed records of patients undergoing EP procedures at a single, tertiary care medical center who had procedure-related acute hemopericardium requiring emergency pericardiocentesis during a three-year period. Procedure details, transfusion volumes, and clinical outcomes of patients who received direct autotransfusion of aspirated pericardial blood via a femoral venous sheath were compared to those of patients who did not receive direct autotransfusion. RESULTS During the study period, 10 patients received direct autotransfusion (group 1) and outcomes were compared with those of 14 control patients who did not receive direct autotransfusion (group 2). Volume of aspirated pericardial blood was similar in groups 1 and 2 (1.6±0.7 L vs. 1.3±1.0 L, respectively; p=0.52). Amongst patients with aspirated volumes less then 1L, group 1 patients (n=4) were less likely than group 2 patients (n=8) to require allotransfusion (0% vs. 75%, p=0.02). Amongst patients with aspirated volume ≥ 1L, group 1 patients (n=6) required fewer units of red cell allotransfusion than group 2 patients (n=6) (1.5±0.8u vs. 4.3±2.0u, p=0.01). No procedural complications related to direct autotransfusion occurred. CONCLUSIONS Direct autotransfusion following emergency pericardiocentesis during electrophysiology procedures requiring systemic anticoagulation is feasible and safe. Utilization of direct autotransfusion may eliminate or reduce the need for allotransfusion. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.Enduring isolation of the pulmonary veins (PV) is becoming increasingly common in patients undergoing repeat catheter ablation for atrial fibrillation. We describe our approach to ablation strategy in a patient with enduring isolation of PV and briefly discuss the role of non-PV triggers. © 2020 Wiley Periodicals, Inc.Merkel cell carcinoma (MCC) is a rare, aggressive primary cutaneous neuroendocrine cancer which almost always exhibits the cytokeratin (CK)20+/thyroid transcription factor (TTF)-1- immunophenotype. MCC may occur concurrently with squamous cell carcinoma (SCC), Bowen's disease, and/or basal cell carcinoma (BCC), with some evidence that MCCs which occur in conjunction with other neoplasms exhibit different immunophenotypes compared to pure MCC cases. We present a case of CK20-/TTF-1+ MCC concurrent with Bowen's disease and BCC, and discuss possible differences in the pathogenesis of pure vs combined MCC. We also review the literature for this unusual immunophenotype, noting that most cases occur in combined MCC. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.The programmed cell death-1 (PD-1)/programmed cell death ligand 1 (PD-L1) pathway is an important host immunosuppression mechanism. Soluble PD-1 (sPD-1) and PD-L1 (sPD-L1) expression regulates co-inhibitory signals in autoimmune disorders. Here, we evaluated whether serum sPD-1 and sPD-L1 is involved in immune dysfunction and assessed its relationship with SLE. Blood samples were obtained from 130 patients with SLE and 44 healthy controls. link3 Serum sPD-1 and sPD-L1 were tested by enzyme-linked immunosorbent assay (ELISA). Relevant immune parameters were analyzed. Both serum sPD-1 and sPD-L1 were significantly higher in the SLE patients than in the controls. A series of severe disease clinical manifestations and laboratory features such as presence of decreased complement component 3, complement component 4 and SLEDAI > 8 were associated with elevated sPD-1 and sPD-L1. Our study suggests that abnormal sPD-1 and sPD-L1 expression may be involved in the imbalance of immune regulation in SLE. This article is protected by copyright. All rights reserved.Radiation is the most effective treatment for localized lymphoma, but treatment of multifocal disease is limited by toxicity. Radioimmunotherapy (RIT) delivers tumoricidal radiation to multifocal sites, further augmenting response by dose-escalation. This phase II trial evaluated high-dose RIT and chemotherapy prior to autologous stem-cell transplant (ASCT) for high-risk, relapsed or refractory (R/R) B-cell non-Hodgkin lymphoma (NHL). The primary endpoint was progression free survival (PFS). Secondary endpoints were overall survival (OS), toxicity, and tolerability. Patients age less then  60 years with R/R NHL expressing CD20 were eligible. Mantle cell lymphoma (MCL) patients could proceed to transplant in first remission. Patients received I-131-tositumomab delivered at ≤ 25Gy to critical normal organs, followed by etoposide, cyclophosphamide and ASCT. 107 patients were treated including aggressive lymphoma (N=29), indolent lymphoma (N=45), and MCL (N=33). After a median follow-up of 10.1 years, the 10-year PFS for the aggressive, indolent, and MCL groups were 62%, 64%, 43% respectively. The 10-year OS for the aggressive, indolent, and MCL groups were 61%, 71%, 48% respectively. Toxicities were similar to standard conditioning regimens and non-relapse mortality at 100 days was 2.8%. Late myeloid malignancies were seen in 6% patients. High-dose I-131-tositumomab, etoposide and cyclophosphamide followed by ASCT appeared feasible, safe, and effective in treating NHL, with estimated PFS at 10-years of 43-64%. In light of novel cellular therapies for R/R NHL, high-dose RIT-containing regimens yield comparable efficacy and safety and could be prospectively compared. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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